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Stroke. 2018 Apr;49(4):972-979. doi: 10.1161/STROKEAHA.117.019861.

Improving Community Stroke Preparedness in the HHS (Hip-Hop Stroke) Randomized Clinical Trial.

Author information

1
From the Department of Neurology, Columbia University Medical Center, New York, NY (O.W., E.L.-H.Q., J.N.); Research Division, Hebrew Home at Riverdale, Bronx, NY (J.P.E., J.K., J.T.); Columbia University Stroud Center at New York State Psychiatric Institute (J.T.); and Department of Population Health, NYU School of Medicine (G.O.). ow11@cumc.columbia.edu.
2
From the Department of Neurology, Columbia University Medical Center, New York, NY (O.W., E.L.-H.Q., J.N.); Research Division, Hebrew Home at Riverdale, Bronx, NY (J.P.E., J.K., J.T.); Columbia University Stroud Center at New York State Psychiatric Institute (J.T.); and Department of Population Health, NYU School of Medicine (G.O.).

Abstract

BACKGROUND AND PURPOSE:

Deficiencies in stroke preparedness cause major delays to stroke thrombolysis, particularly among economically disadvantaged minorities. We evaluated the effectiveness of a stroke preparedness intervention delivered to preadolescent urban public school children on the stroke knowledge/preparedness of their parents.

METHODS:

We recruited 3070 fourth through sixth graders and 1144 parents from 22 schools into a cluster randomized trial with schools randomized to the HHS (Hip-Hop Stroke) intervention or attentional control (nutrition classes). HHS is a 3-hour culturally tailored, theory-based, multimedia stroke literacy intervention targeting school children, which systematically empowers children to share stroke information with parents. Our main outcome measures were stroke knowledge/preparedness of children and parents using validated surrogates.

RESULTS:

Among children, it was estimated that 1% (95% confidence interval [CI], 0%-1%) of controls and 2% (95% CI, 1%-4%; P=0.09) of the intervention group demonstrated optimal stroke preparedness (perfect scores on the knowledge/preparedness test) at baseline, increasing to 57% (95% CI, 44%-69%) immediately after the program in the intervention group compared with 1% (95% CI, 0%-1%; P<0.001) among controls. At 3-month follow-up, 24% (95% CI, 15%-33%) of the intervention group retained optimal preparedness, compared with 2% (95% CI, 0%-3%; P<0.001) of controls. Only 3% (95% CI, 2%-4%) of parents in the intervention group could identify all 4 letters of the stroke FAST (Facial droop, Arm weakness, Speech disturbance, Time to call 911) acronym at baseline, increasing to 20% at immediate post-test (95% CI, 16%-24%) and 17% at 3-month delayed post-test (95% CI, 13%-21%; P=0.0062), with no significant changes (3% identification) among controls. Four children, all in the intervention group, called 911 for real-life stroke symptoms, in 1 case overruling a parent's wait-and-see approach.

CONCLUSIONS:

HHS is an effective, intergenerational model for increasing stroke preparedness among economically disadvantaged minorities.

CLINICAL TRIAL REGISTRATION:

URL: https://clinicaltrials.gov. Unique identifier: NCT01497886.

KEYWORDS:

child; multimedia; parents; school; speech

PMID:
29567762
PMCID:
PMC5871596
DOI:
10.1161/STROKEAHA.117.019861
[Indexed for MEDLINE]
Free PMC Article

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